Accommodative Esotropia During the First Year of Life

Two infants developed accommodative esotropia during their first six months of life. One infant, whose age at onset was 4 1/2 months, had 4.50 diopters of hyperopia. The second infant, whose age at onset was 5 months, had 3.50 diopters of hyperopia. In both infants, the eyes completely aligned with hyperopic correction. Two points are stressed. First, when the amount of hyperopia exceeds +3.00, consideration should be given to an accommodative element as the cause of the esotropia, even if the child is only 4 to 6 months old. Second, even with small angles of esotropia, an accommodative element should be considered, if there is a substantial amount of hyperopia.